Brain Advance Access originally published online on April 19, 2007
Brain 2007 130(5):1338-1349; doi:10.1093/brain/awm046
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Multicentric French study on adult intracranial ependymomas: prognostic factors analysis and therapeutic considerations from a cohort of 152 patients
1Department of Neurosurgery, Timone Hospital, Marseille, France, 2Neuro-oncological Unit, Timone Hospital, Marseille, 3Department of Pathology and Neuropathology, Timone Hospital, Marseille, 4Department of Biostatistics, Timone Hospital, Marseille, 5Department of Pathology and Neuropathology, "Pierre Wertheimer" Neurological Hospital, Lyon and 6Department of Neurosurgery, "Pierre Wertheimer" Neurological Hospital, Lyon, France For the Club de Neuro-Oncologie de la Société Française de Neurochirurgie (SFNC) and the Association des Neuro-Oncologues d’Expression Française (ANOCEF)
Correspondence to: Philippe Metellus, MD, Service de Neurochirurgie du Professeur GRISOLI, Hôpital de la TIMONE, 264, rue Saint-Pierre, 13385 Cedex Marseille, France E-mail: philippe.metellus{at}mail.ap-hm.fr
Ependymomas account for 2% of all intracranial tumours in adults. Considerable controversy continues to exist with regard to their prognostic factors and therapeutic management due to the rarity and the heterogeneity of series reported so far. The authors report a retrospective study of a homogenous population of 152 adult patients harbouring intracranial ependymomas from 24 French Neurosurgical Centres between 1990 and 2004. All clinico-radiological and follow-up data were analysed and a central pathologic review was performed by two confirmed neuropathologists. The 5- and 10-year overall survival rates were 84.8 and 76.5%, respectively; the 5- and 10-year progression-free survival rates were 63.5 and 52.8%, respectively. On multivariate analysis, overall survival rates were associated with histological grade (P < 0.001), extent of surgery (P = 0.006), patient age (P = 0.004) and patient Karnofski performance status (P = 0.03). The multivariate analysis also revealed that the risk of recurrence was associated with high histological grade (P < 0.001), incomplete resection (P < 0.001) and Karnofski performance status 
80 (P = 0.04). The impact of radiotherapy was found to be beneficial for incompletely resected low-grade ependymomas and to a lesser extent for completely removed high-grade tumours. In association with Karnofski performance status and extent of surgery, histological grade is a major prognostic factor in adult intracranial ependymomas. The application of a simple and reproducible grading scheme using objective anaplastic criteria seems useful practically and clinically applicable. The role of adjuvant radiotherapy for patients with incompletely resected low-grade ependymomas seems to be beneficial but remains to be addressed for high-grade tumours.
Key Words: ependymoma; adult; prognostic factors; radiotherapy; classification
Abbreviations: CART, classification and regression tree; GTR (+), gross total removal; GTR (–), incomplete resection; KPS, Karnofski performance status; LV, lateral ventricle; Max, maximum; Min, minimum; OS, overall survival; P, parenchymal; PFS, progression-free survival; RPA, recursive partition analysis; RT, radiotherapy; V3, third ventricle; WHO, World Health Organization
Received November 4, 2006. Revised February 10, 2007. Accepted February 15, 2007.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. O. Hanemann Magic but treatable? Tumours due to loss of Merlin Brain, March 1, 2008; 131(3): 606 - 615. [Abstract] [Full Text] [PDF]
|
|